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Clinical course of patients with hyponatremia and decompensated systolic heart failure and the effect of vasopressin receptor antagonism with tolvaptan

Författare och institution:
P. J. Hauptman (-); J. Burnett (-); M. Gheorghiade (-); L. Grinfeld (-); M. A. Konstam (-); D. Kostic (-); H. B. Krasa (-); A. Maggioni (-); J. Ouyang (-); Karl Swedberg (Institutionen för medicin, avdelningen för molekylär och klinisk medicin); F. Zannad (-); C. Zimmer (-); J. E. Udelson (-)
Publicerad i:
Journal of Cardiac Failure, 19 ( 6 ) s. 390-7
ISSN:
1071-9164
E-ISSN:
1532-8414
Publikationstyp:
Artikel, refereegranskad vetenskaplig
Publiceringsår:
2013
Språk:
engelska
Fulltextlänk:
Sammanfattning (abstract):
BACKGROUND: Patients with decompensated heart failure, volume overload, and hyponatremia are challenging to manage. Relatively little has been documented regarding the clinical course of these patients during standard in-hospital management or with vasopressin antagonism. METHODS AND RESULTS: The Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan database was examined to assess the short-term clinical course of patients hospitalized with heart failure and hyponatremia and the effect of tolvaptan on outcomes. In the placebo group, patients with hyponatremia (serum Na(+) <135mEq/L; n = 232), compared with those with normonatremia at baseline (n = 1785), had less relief of dyspnea despite receiving higher doses of diuretics (59.2% vs 69.2% improved; P < .01) and worse long-term outcomes. In the hyponatremia subgroup from the entire trial cohort (n = 475), tolvaptan was associated with greater likelihood of normalization of serum sodium than placebo (58% vs 20% and 64% vs 29% for day 1 and discharge, respectively; P < .001 for both comparisons), greater weight reduction at day 1 and discharge (0.7 kg and 0.8 kg differences, respectively; P < .001 and P = .008), and greater relief of dyspnea (P = .03). Among all hyponatremic patients, there was no effect of tolvaptan on long-term outcomes compared with placebo. In patients with pronounced hyponatremia (<130 mEq/L; n = 92), tolvaptan was associated with reduced cardiovascular morbidity and mortality after discharge (P = .04). CONCLUSIONS: In patients with decompensated heart failure and hyponatremia, standard therapy is associated with less weight loss and dyspnea relief, and unfavorable longer-term outcomes compared to those with normonatremia. Tolvaptan is associated with more favorable in-hospital effects and, possibly, long-term outcomes in patients with severe hyponatremia.
Ämne (baseras på Högskoleverkets indelning av forskningsämnen):
MEDICIN OCH HÄLSOVETENSKAP ->
Klinisk medicin
Nyckelord:
Heart failure; hyponatremia; prognosis; vasopressin antagonist
Postens nummer:
180386
Posten skapad:
2013-07-31 10:05
Posten ändrad:
2016-06-10 13:26

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